Mavericks of health care #4: Kari Niblack

I have talked with many mavericks over the last few months.  In a series of four vignettes, I am happy to share some key insights and a look into the philosophies and paradigms that make someone a maverick of health care.

Common values exemplified by health care mavericks

• Caring and competence
• Innovation partnership
• Appropriateness and stewardship
• Trust and advocacy

Be sure to read the part one, featuring Nancy Giacolone, president and owner of Olympic Crest Insurance; part two, featuring Doug Hetherington, CEO & Program Architect at HealtH2Business; and part three, featuring Craig Clemente, President & COO, Specialty Care Management.

Vignette #4 in a four-part series:

Kari Niblack, Esq:   CEO; ACS Benefit Services, LLC Maverick Value:  Trust & Advocacy “It’s not about me” – “The devil is in the details” 

I think that we seek transparency because of a lack of trust.  When pricing is inappropriate and we have a lack of trust, transparency is a tool that helps us hold each other accountable.  You have talked a lot about advocacy and transparency, or integrity.

Q: Can you share how, as a TPA, balancing trust (comprised of integrity and transparency) with advocacy is critical and what are the challenges inherent in balancing these with groups, brokers, and patients?   How do these values play a role in innovation and creating meaningful change in our industry?

The role of a TPA is quite robust and often not fully understood.  Kari shared a deep understanding and respect for the weighty responsibility she and her colleague TPAs share in terms of safeguarding, protecting, and putting the funds of the client/employer to work. The TPA is not only the processor and payer of claims but truly acts as a steward of the monies for their clients.  The day-to-day work in terms of processing claims, accuracy in paying those claims, the details in reviewing SPDs, responding to member concerns, building relationships, and even the solutions offered, are a reflection of that chief aim of stewardship.

When asked how these values show up for her and her team on a day to day basis, she responded that “everything they do is a reflection of that responsibility to protect the funds of the client”,  and that “the devil is in the details.”  Outside of payroll, benefits are the #1 cost for an employer. She and her team – like all good TPAs – earn the trust of their clients because of the understanding of their role in the impact the client’s greatest asset:  their employees.

She likened the role of the TPA as that of a “quarterback” in that so much of the role involves customization of every aspect of the client’s needs.  Working with the client and the broker, she is tasked with figuring out the needs and goals of the client and matching them with the resources and support to drive those desired outcomes.

There is a great similarity in her role to that of a clinician.  She shared how in consulting with her clients – “It’s not about me.”  She starts her consultation much as a clinician in that first, she must have a deep understanding of the client’s goals: Who are they?  What is important to this group?  What are the pain points and the long and short-term business goals of the client?  A deep dive into the data and analytics provides a story that is uses as a tool for an assessment she provides in her consultation – much like laboratory values share a story that a physician uses in developing a holistic picture of what is going on in a patient.  So just as a clinician first gathers information and data to form an assessment in order to make judicious recommendations for the best interests of the patient, so too does a TPA first assess all the information to appropriately consult and make recommendations for the client.  Before they can even recommend the right products, they must first understand, in a multi-faceted way, what the makeup and goals of the client and their member population is.

“There is no box” for the role of the TPA, she said, as she held up a square that represented the TPA role – and then tore it up.  The trusted TPA must wield the skill, competence, caring, and broad understanding of resources and solutions in order to truly tailor the plan for the group – all while aligning and protecting incentives for all of the players that are working together for the interests of the employer.

The plan developed with the client has everything to do with the significant life events of their membership; this is such a serious responsibility that the extreme diligence, respect, stewardship and trust placed on the TPA cannot be understated.

Her counsel for those players at the table who interface with the TPA involved nurturing relationships and taking the time to develop the relationships that lead to the collaboration and partnership that drives the success in providing the services and support that ensures the member/patient in the center is taken care of with excellence.  She also shared how important it is for all of us to be “students in the industry.”  Seeking continued learning and growth is important to continue to provide the value that is the responsibility of the Maverick.